Monthly Archives: January 2011

Using a novel surgical approach, it’s possible to rebuild the trachea and preserve a patient’s voice after removing an invasive throat tumor, according to a new report from Henry Ford Hospital in Detroit.

This case study is the first of its kind to not only document a successful technique to create a fully functional trachea, or windpipe, but also report a rare type of malignant tumor in an adult’s trachea. Most commonly, this type of tumor is seen in newborns and very rarely occurs in the neck, says lead study author Samer Al-Khudari, M.D., with the Department of Otolaryngology-Head & Neck Surgery at Henry Ford Hospital.

“In this case, the patient’s tumor had spread to the trachea, thyroid gland, muscles around the thyroid gland and nerves in the area,” says Dr. Al-Khudari.

According to head and neck cancer surgeon Tamer A. Ghanem, M.D., Ph.D., who led the Henry Ford surgical team, the easiest approach would have been to remove the trachea and the voice box, given the tumor’s proximity to the larynx and other surrounding structures. With this method, however, the patient would no longer be able to speak or swallow normally.

Instead, the surgical team took another approach. Using tissue and bone from the patient’s arm, they were able to reconstruct the trachea, restoring airflow through the trachea and saving the patient’s voice.

“We had to think outside the box to not only safely remove the tumor, but to allow for optimum functional outcome,” says Dr. Ghanem, director of the Head and Neck Oncology & Microvascular Surgery Division at Henry Ford. “This is the first time such a large portion of a patient’s trachea has been removed and rebuilt in a way that allows it to be fully functional.”

This unique case will be presented Jan. 29 at the poster session for the Triological Society’s Combined Section Meeting in Scottsdale, Ariz.

The case study is centered on a 27 year-old man who had a large mass blocking 90 percent of his airway, making it very difficult for him to breathe.

After a biopsy and other tests, Henry Ford doctors determined the mass was a malignant immature teratoma – a cancerous tumor that was quickly spreading throughout the areas of the patient’s trachea and surrounding structures.

Such tumors are extremely rare; since the first reported case in 1854, there have only been 300 other reported cases.

With the Henry Ford patient, surgeons first removed the tumor and about half of the patient’s airway, just below the voice box.

Using bone and skin from the patient’s arm and two titanium plates, surgeon’s reconstructed the airway, providing it with full coverage and allowing it to be fully functional.

Reconstruction of the trachea is challenging, due to the structural complexity and unique properties of the airway. The ideal reconstruction must not collapse during respiration and have some degree of mobility to allow for neck movement.

Currently the patient is using a tracheostomy tube – a tube that is inserted into an opening in the trachea to assist with breathing – but the surgeons do not expect it to be permanent. OCF The patient, however, is able to speak and swallow normally. He also underwent chemotherapy as part of his treatment.

Like any other high school kid, Stephen Strasburg wanted to emulate the major league baseball players he watched on television. He mimicked their actions down to the last detail. He rolled his pants up to reveal high socks, wore wristbands at the plate and, during downtime, opened tins of chewing tobacco and pinched some in his lower lip.

Years later, having developed a powerful addiction, Strasburg regrets ever trying smokeless tobacco. Last fall, Tony Gwynn – his college coach at San Diego State and one of those players he grew up idolizing – began radiation treatments for parotid cancer, a diagnosis Gwynn blamed on using smokeless tobacco.

In the wake of Gwynn’s cancer diagnosis, Strasburg has resolved to quit smokeless tobacco while he recuperates from Tommy John surgery. He doesn’t want to face the myriad health risks borne from tobacco use, and he doesn’t want kids who want to be like him to see him with a packed lower lip. Strasburg conflates many activities with dipping, and he has yet to eradicate the habit. But he is determined he will.

“I’m still in the process of quitting,” Strasburg, 22, said. “I’ve made a lot of strides, stopped being so compulsive with it. I’m hoping I’m going to be clean for spring training. It’s going to be hard, because it’s something that’s embedded in the game.”

Smokeless tobacco has long been entrenched in baseball. In the 1980s, wads of it bulged in batters’ cheeks. More recently, tins of what players call “dip” form circular outlines on players’ back pockets. Managers, players and coaches use it occupy time during the lulls of a game and to feel the rush of nicotine it provides, a momentary buzz of energy that many come to believe – erroneously – benefits their performance.

The habit carries a steep risk. Smokeless tobacco can lead to several forms of mouth cancer that require a series of disfiguring surgeries; many patients have their entire jaw removed. The juices swallowed contain heavy metals and can lead to esophageal and pancreatic cancer, two of the direst cancers to treat. White, precancerous lesions appear on the lips. Gums recede. Teeth become discolored and loosen.

“It’s nasty stuff,” said Gregory Connolly, a Harvard professor who has lectured major league players and testified before Congress on the ills of smokeless tobacco. “There’s no other way to look at it.”

For two decades, there has been a fight to educate players on the danger and eradicate smokeless tobacco from baseball, both for the health of players and for the health of children who watch and idolize them. Several congressional hearings, including one last April, have addressed the issue. Major League Baseball has urged players to not use it when on camera. Since 1993, all tobacco products have been banned in the minor leagues on fields, in clubhouses and during team travel. It’s also banned in college and in every significant amateur association.

And yet, experts say, the usage among major league players has remained steady. Roughly 33 percent of major league players, Connolly said, use some form of smokeless tobacco, a rate that has remained stagnant. More dispiriting, its use has risen among young males. The only significant increase of any tobacco product over the last five years, according to Connolly and other advocates, has been the use of smokeless among youths. It has increased to 25 percent, compared with 16 percent of the general population.

“It hasn’t changed that much,” says Joe Garagiola, his voice dripping with a frustration bordering on depression. Garagiola, a former player and major league executive, chewed himself as a player in the ’40s, believing, as so many players still do, that chewing tobacco is a rite of passage. He quit after his daughter asked if he was going to die. Later in life, he watched his friend Bill Tuttle, a former major leaguer, lose his jaw and then succumb to cancer caused by spit tobacco.

For two decades, Garagiola campaigned against smokeless tobacco in baseball. He gave speeches during spring training. He testified before Congress. At his home in Arizona, he keeps a box full of newspaper stories, fact sheets and advertisements for smokeless tobacco.

He still pleads with players to not put tins in their back pocket, a possible example for kids. The dearth of progress is difficult for him to bear.

“I’m to the point where you’re ready to put up the flag and say, ‘You win,’ ” Garagiola said. “The frustration is so deep. There’s nothing I can do about it. It hurts me. It really does. If baseball would just simply say we are banning tobacco from the field – but no. It’s a collective bargaining piece.”

Ban would mean bargain
Tobacco has not been banned in the majors, Garagiola and other experts say, because MLB and the players’ union view smokeless tobacco as a collective bargaining issue rather than a health issue. The players’ association will not yield to a ban without a concession, and the league has been unwilling to cede anything to implement a ban.

The next round of collective bargaining will take place this year, before the current Basic Agreement expires Dec. 11. Some momentum for a ban has gathered. During a House Energy and Commerce Committee Hearing, Rep. Henry Waxman (D-Calif.) called for baseball to ban all tobacco at the park. “Millions of young fans are exposed on a daily basis to the use of smokeless tobacco by their heroes,” Waxman said during the hearing.

In November, 10 anti-tobacco organizations, including the American Cancer Society and the Campaign for Tobacco-Free Kids, sent a letter to Commissioner Bud Selig and MLB Players Association head Michael Weiner urging a ban. “There is an unmistakable urgency for the players and team management to address this issue now,” the letter read.

“As a matter of policy, we don’t speak publicly about what we’re going to propose at the negotiating table,” MLB Executive Vice President Rob Manfred said. “What I will tell you is that smokeless tobacco remains a significant concern to Major League Baseball. Generally, our minor league policy reflects where we’re we’d like to be.”

“Despite its long-standing use throughout the history of the game, the union discourages the use of smokeless tobacco and has worked with the Commissioner’s Office to help make players aware of the health risks associated with these products,” Weiner said in a statement. “We have discussed this issue with players in anticipation of our upcoming collective bargaining negotiations.”

Weiner declined to address follow-up questions through a spokesman, not wanting to elaborate on a bargaining position.

Connolly drew a parallel between steroid testing and banning tobacco. Immense public scorn eventually pressured the players’ association into accepting tests for performance-enhancing drugs. Smokeless tobacco, meanwhile, has been left largely unregulated at the major league level. Connolly recalls reading a cover of Sports Illustrated decrying the use of steroids in baseball. On the back cover was an advertisement for a smokeless tobacco company.

“I looked at it and said, ‘This is insane,’ ” Connolly said. “If you’re looking at drugs, what is the most-abused drug by major league baseball players? It’s smokeless tobacco. There’s no question. What has the potential to do more harm to American kids in terms of addiction? It’s smokeless tobacco. It’s not steroids.”

Quitting has side effects
Smokeless tobacco use in baseball persists, in part, because of its powerful addictive quality. The rush or buzz players feel, studies have shown, is not actually a burst of energy, but rather a means to ease withdrawal symptoms.

Spit tobacco uses a different delivery system than cigarettes. Its high concentration of nicotine reaches the brain through mucous membranes in the mouth. In level of addiction, smokeless tobacco is more similar to cocaine than cigarettes, experts say.

And so quitting leads to a battery of side effects – sleep disruption, upset stomach, depression, headaches, lack of concentration. It is nearly impossible to play baseball under such conditions, which makes quitting during the season untenable and strengthens tobacco’s grip on players. Using may not help performance, but quitting certainly hurts.

“When they use again, they feel better and their performance is better,” said Thomas Glynn, an expert with the American Cancer Society. “But it’s not the smokeless that is helping. It’s the absence of withdrawal symptoms.”

Strasburg, then, has chosen the right time to quit. He will not have to worry about his performance for the Washington Nationals until the very end of 2011 at the earliest, and more likely until 2012. “He’s in a good position right now,” Glynn said. “If he can use this time to quit, it’s a good opportunity for him – and for any people who admire him.”

Strasburg has decided to quit as much for himself as for the countless kids who have watched him become one of baseball’s most recognizable players.

“I was one of those kids that picked it up based on seeing ballplayers do it,” Strasburg said. “It’s not a good thing, and I don’t want to represent myself like that. That’s one of the big reasons. Another reason is, when I do have kids, I don’t want my kids to be like that, too.”

Strasburg stressed that his decision to quit is an individual choice. He wants to set a good example for children who watch baseball, not necessarily set a directive for teammates.

“I’m not going to sit here and be the spokesperson for quitting dipping,” Strasburg said. “I’m doing it for myself. I’m not saying anything about anybody else – it’s their personal choice. For me, it’s the best decision.”

They say lightning never strikes the same place twice—unless, of course, that place is a lightning rod. An enzyme called UROD acts like a lightning rod for cancer cells, drawing radiation and chemotherapy toward specific spots in diseased tissue, a new study in mice and humans reports in Science.

The findings suggest that UROD—identified for the first time in this paper as a key player in human cancer–could help decrease treatment side effects for people with head and neck cancer, the eighth most common cancer worldwide. Despite many advances over the last few decades, the toxic side effects associated with current therapies have made for disappointing outcomes in many patients. Head and neck tumors are often found near critical organs, so destroying the diseased tissue is often a delicate challenge that could lead to life-threatening conditions.

Here, Emma Ito and colleagues show that targeting UROD can selectively enhance the effects of radiation and chemotherapy in head and neck tumors, while minimizing toxicity to normal tissues. By focusing therapy toward specific parts of tissue, lower doses of radiation and chemotherapeutic drugs could potentially be administered to patients without compromising treatment efficacy. Uroporphyrinogen decarboxylase or UROD is an enzyme involved in the production of a molecule called heme, which is vital for all of the body’s organs (though it is most abundant in the blood, bone marrow, and liver).

Heme is an essential component of iron-containing proteins called hemoproteins, including hemoglobin, the protein that carries oxygen in the blood.The authors discovered by high-throughput RNA interference screening that UROD is a potent tumor-selective sensitizer for both radiation and chemotherapy. In mice, blocking expression of the UROD gene increased cancer cell death. Analyses of head and neck cancer tissue samples revealed that UROD levels were significantly higher in tumors than in normal tissues.

Moreover, the researchers determined that improved clinical outcome was linked to lower UROD levels in patients, suggesting that UROD could potentially be used to predict patients’ response to radiation. The authors hope that UROD inhibitors could one day be used in conjunction with radiation and chemotherapy to minimize side effects.

Source: “Uroporphyrinogen Decarboxylase Is a Radiosensitizing Target for Head and Neck Cancer,” by E. Ito et al., Science, January 2011.

Background:
Cancer-associated weight loss may be mediated by an inflammatory response to cancer. Eicosapentaenoic acid (EPA) may suppress this response.

Methods:
Beginning no later than 2 weeks before surgery, patients with head and neck cancer and with weight loss, who were undergoing major resection with curative intent consumed a protein- and energy-dense nutritional supplement containing EPA from fish oil, in addition to usual diet or tube feed.

Radiation-related xerostomia has been the most significant and disabling side-effect of radiotherapy for head and neck cancer for more than 50 years. With the PARSPORT trial, reported in The Lancet Oncology, the largest and best designed of several randomised trials focusing on xerostomia, radiation oncologists and their partners in physics and dosimetry should take pride that significant progress has been made. Before the introduction of intensity-modulated radiotherapy (IMRT), more than 80% of survivors experienced substantial dry mouth syndrome and associated effects on dental health, swallowing, taste, and quality of life. By contrast, Nutting and colleagues report about 25% of 2-year survivors had significant clinician-rated xerostomia. Taken together with two randomised trials of IMRT for nasopharyngeal cancer, there is now compelling evidence of the power of advanced technology in reducing toxicity from head and neck radiotherapy.

Can even better use of technology help us to further reduce xerostomia? The parotid glands provide watery saliva during eating, which is largely replaceable by consuming more water or lubricants. The submandibular, sublingual, and minor salivary glands provide mucinous saliva, associated with the resting sense of moisture and dry mouth symptoms. Future work should systematically explore the prioritisation of different components of the salivary gland system. A clinical benefit from sparing the submandibular glands may be seen, beyond that seen by sparing the parotid glands. The mean dose delivered to the minor salivary glands within the oral cavity has also been reported to be a significant factor in patient-reported xerostomia. Further possibilities include gland repair or regenerative strategies with stem cells, acupuncture, or acupuncture-like stimulation. The promise of intensity-modulated protons provides even more optimism for reducing xerostomia and other acute and late effects.

Another important aspect of PARSPORT is the evolution of quantitative methods to assess xerostomia—eg, pre and post stimulation salivary flow, quality of life, clinical grading, and diet tolerance scales. While there is no agreement on which is the gold standard, we should use multiple measures which reflect different aspects and perspectives (patient clinician) on the issue. One must recognise an inherent weakness in technology-based xerostomia trials: neither patients nor clinicians are blinded. However, for those practicing radiotherapy for head and neck cancer, and for our patients, the improved outcomes are empirically obvious every day. Xerostomia is now an uncommon first complaint among survivors more than 3 months from treatment. This concern has been replaced by the next most bothersome issues: swallowing, taste, and fatigue. Reduction in the burden of treatment-related side-effects is especially important given the increasing number of patients presenting with oropharyngeal cancer (85% of patients in PARSPORT had disease at this site), related to the surge in cases of HPV infection. Considering the excellent prognosis of patients with oropharyngeal cancer with no or minimal smoking history (>80% 3-year survival), the potential for striking reductions in duration and magnitude of symptom burden is clear. Several ongoing studies are examining strategies to reduce treatment intensity for these patients, including radiation dose reduction, and substitution of cytotoxic drugs with targeted agents (eg, the recently approved RTOG-1016 for HPV-positive cancers).

Lastly, a recent report suggests that surgical relocation of a submandibular gland might be an effective way to reduce the sense of dry mouth at rest. This intervention can be applied anywhere surgeons are trained for this procedure, in collaboration with two-dimensional radiotherapy, and demands further investigation. Some of us may under-appreciate that IMRT technology is available to less than 10% of the global population. Salivary gland transfer thus may have a more immediate and long-term effect on the global burden of radiation-related xerostomia than all the beam modulation done for many decades.

Objectives:
Investigate the use of optical reflectance spectroscopy to differentiate malignant and nonmalignant tissues in head and neck lesions and characterize corresponding oxygen tissue biomarkers that are associated with pathologic diagnosis.

Study Design:
Cross-sectional study.

Setting:
Tertiary Veterans Administration Medical Center.

Subjects and Methods:
All patients undergoing panendoscopy with biopsy for suspected head and neck cancer were eligible. Prior to taking tissue samples, the optical probe was placed at 3 locations to collect diffuse reflectance data. These locations were labeled “tumor,” “immediately adjacent,” and “distant normal tissue.” Biopsies were taken of each of these respective sites. The diffuse reflectance spectra were analyzed, and biomarker-specific absorption data were extracted using an inverse Monte Carlo algorithm for malignant and nonmalignant tissues. Histopathological analysis was performed and used as the gold standard to analyze the optical biomarker data.

Results:
Twenty-one patients with mucosal squamous cell carcinoma of the head and neck were identified and selected to participate in the study. Statistically significant differences in oxygen saturation (P = .001) and oxygenated hemoglobin (P = .019) were identified between malignant and nonmalignant tissues.

Conclusion:
This study established proof of principle that optical spectroscopy can be used in the head and neck areas to detect malignant tissue. Furthermore, tissue biomarkers were correlated with a diagnosis of malignancy.

January 28, 2011 — A new policy statement from the American Society of Clinical Oncology (ASCO) aims to improve communication with, and decision making for, patients with advanced cancer (defined as incurable disease).

It calls for a change in paradigm for advanced cancer care and a new approach in which all available treatment options are discussed from the very beginning.

The statement was published online on January 24 in the Journal of Clinical Oncology.

“While improving survival is the oncologist’s primary goal, helping individuals live their final days in comfort and dignity is one of the most important responsibilities of our profession,” ASCO president George Sledge, MD, said in a statement.

“Oncologists must lead the way in discussing the full range of curative and palliative therapies to ensure that patients’ choices are honored,” he said.

New Paradigm of Care

This new approach “requires stepping back from the paradigm of applying one line of therapy after the other and focusing primarily on disease-directed interventions,” say the authors, comprised of a panel of oncologists and specialists in palliative care.

“Instead, we need to move toward developing a treatment plan that is consistent with evidence-based options (including disease-directed and palliative care), and the patients’ informed preferences for how we pursue and balance these options throughout the course of illness,” they add.

Conversations about all of the options that are available must be started earlier, and they must be more thorough, the panel insists.

“These conversations should be going on throughout the course of the patient’s illness,” lead author Jeffrey Peppercorn, MD, PhD, medical oncologist at Duke University in Durham, North Carolina, said in an interview.

A lot of the press coverage about this new initiative has focused on end-of-life care; this is a mistake, he said. “That is involved, of course, but the main point is to begin these conversations early on, when the patient is first diagnosed, and then continue the dialogue at regular intervals throughout the illness.”

“We know that patients with advanced cancer have many different treatment options, and often the focus is — appropriately — on disease-directed therapy and what will work best to treat the cancer,” explained Dr. Peppercorn.

“But we need to remember the patients’ symptoms and their preferences, and strike the right balance between disease-directed and supportive therapy,” he continued. The early involvement of palliative care might not only improve symptoms and quality of life but, at least in one study, it also improved survival, he pointed out.

“We must remember to treat the patient and not just the cancer,” he added.

Candid Conversations

The policy statement outlines step-by-step recommendations to ensure that physicians initiate candid discussions about the full range of palliative care and treatment options soon after a patient’s diagnosis. ASCO will follow this up with a clinical guidance document later in the year, and there will be several educational sessions on this topic at the annual meeting.

As a complement to this initiative, ASCO has released a guide for patients with advanced cancer to help them broach difficult conversations about their prognosis, treatment, and palliative care options with their physicians.

“Candid conversations are key,” Dr. Peppercorn and colleagues write. “Physicians should initiate candid discussion about prognosis with their patients soon after an advanced cancer diagnosis.”

However, recent studies suggest that such conversations currently occur in less than 40% of cases.

The authors acknowledge that these conversations are inherently difficult and uncomfortable, but point out that delaying them will only heighten the problem.

“We know that these conversations are difficult, but without them, patients may end up receiving disease-directed care even when there is no realistic chance of benefit, sometimes right up to the last few days of life,” Dr. Peppercorn told Medscape Medical News.

Stopping Anticancer Therapy

Some of the statements in the document appear to be giving permission for both doctors and patients to stop specific anticancer therapy.

“As a guiding principle, anticancer therapy should be considered only when it has a reasonable chance of working and providing meaningful clinical benefit,” according to the document. “Oncologists should feel no obligation to provide an intervention that clinical evidence and the clinician’s best judgment suggest will provide no meaningful benefit to the patient and may cause harm.”

“That is definitely part of it,” explained Dr. Peppercorn. “For both doctors and patients, it’s very hard to step back from the focus on disease-directed therapy . . . . We hope that this new initiative will give permission, and also courage, to both sides to have these very difficult conversations, and will highlight the benefits of having these conversations.”

“Instead of viewing the whole process as fighting, fighting, fighting, and then giving up,” he said, “having these conversations as an ongoing dialogue may lead to better outcomes for the patients. In some instances, stopping cancer therapy may be in the patient’s best interest; they may have a better quality of life for the time they have remaining.”

This can be difficult for oncologists, with their focus on treating cancer, because stopping that treatment can be perceived as a failure. “We want to emphasize the notion that we can continue aggressive treatment of the patient, and instead of focusing on the cancer, we can focus on symptoms through palliative care,” he explained.

“There is no one correct way of doing this, or one best approach that is appropriate for all patients,” Dr. Peppercorn said. This policy document outlines steps that can be followed, but each patient will need an individualized approach, depending on the individual circumstances.

More Time Involved

One of the barriers to implementing this vision of individualized care for patients with advanced cancer is the time involved.

“Engaging in discussions of prognosis, options, and the patients’ goals and preferences requires substantially more time than is commonly allotted for the standard follow-up visit,” the authors write.

“In addition, the current reimbursement system strongly favors intervention over prolonged discussion,” they point out. “There is a misalignment of incentives in the current healthcare system that inadvertently encourages administration of cancer-directed treatment at the end of life, rather than the time-consuming, emotionally challenging discussions that emphasize candor, comfort, family, and quality of life.”

“Efforts to compensate oncologists and others for delivering this important aspect of cancer care were unfortunately politicized in the recent healthcare reform debates,” the authors note. However, these efforts had at their core a critical patient-centered societal interest, and they should be revisited, they urge.

Abstract

Background: Oral cavity squamous cell carcinoma (OCSCC) accounts for 2% to 3% of all malignancies and has a high mortality rate. The majority of anticancer drugs are of natural origin. However, it is unknown whether the medicinal plant Thymus vulgaris L. (thyme) is cytotoxic towards head and neck squamous cell carcinoma (HNSCC). Materials and Methods: Cytotoxicity of thyme essential oil was investigated on the HNSCC cell line, UMSCC1. The IC50 of thyme essential oil extract was 369 μg/ml. Moreover, we performed pharmacogenomics analyses. Results: Genes involved in the cell cycle, cell death and cancer were involved in the cytotoxic activity of thyme essential oil at the transcriptional level. The three most significantly regulated pathways by thyme essential oil were interferon signaling, N-glycan biosynthesis and extracellular signal-regulated kinase 5 (ERK5) signaling. Conclusion: Thyme essential oil inhibits human HNSCC cell growth. Based on pharmacogenomic approaches, novel insights into the molecular mode of anticancer activity of thyme are presented.

Heart disease is a silent killer, but new microchip technology from Rice University is expected to advance the art of diagnosis.

During National Heart Health Month, Rice Professor John McDevitt will discuss the potential of this technology to detect cardiac disease early at the annual meeting of the American Association for the Advancement of Science (AAAS) in Washington, D.C., Feb. 17-21. Cardiac disease is the focus of one of six ongoing major clinical trials of Rice’s programmable bio-nano-chips (PBNCs).

Current clinical trials employ PBNCs to test more than 4,000 patients for signs of heart disease, ovarian cancer, prostate cancer, oral cancer and drug abuse. Versions to test for HIV/AIDS and other diseases are also in development.

“Too often, the first time people know they’re suffering from heart disease is when it kills them,” said McDevitt, Rice’s Brown-Wiess Professor of Chemistry and Bioengineering, who will participate in a global health seminar at AAAS.

“With this test, we expect to save lives and dramatically cut the recovery time and cost of caring for those who suffer from heart ailments,” said McDevitt, a pioneer in the creation of microfluidic devices for biomedical testing. He anticipates the PBNCs, when manufactured in bulk, will cost only a few dollars each.

PBNCs analyze a patient’s saliva for biomarkers associated with cardiovascular disease. Unfortunately, McDevitt said, only about half of the patients having a heart attack are diagnosed immediately via electrocardiogram. The rest require a series of time-consuming laboratory tests that take up to 12 hours to complete. PBNCs now in development deliver results in as little as 20 minutes and provide clinicians with timely information that can help them manage patients more effectively.

“A critical thing to recognize in a heart attack is that if we’re able to open the blocked vessel within an hour, we’ve salvaged a heart muscle,” said Biykem Bozkurt, the Mary and Gordon Cain Chair and Professor of Medicine and director of the Winters Center for Heart Failure Research at Baylor College of Medicine (BCM). “Thus, the patient’s chance of survival is significantly improved.”

Bozkurt and Christie Ballantyne, chief of atherosclerosis and vascular medicine and professor of medicine at BCM and director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart and Vascular Center, are leading the trial at Houston’s Michael E. DeBakey VA Medical Center, one of four sites hosting the cardiac trial that will recruit 1,000 patients.

McDevitt noted that of 5 million visits to American emergency rooms each year for chest pain, approximately 80 percent are false alarms.

“We have patients clogging the ER system and delaying the recognition of true heart attack cases because we can’t, in an expeditious manner, rule out false alarms that could have been diagnosed in the ambulance or the home setting,” said Bozkurt, who also serves as cardiology section chief at the VA.

The potential cost savings for even a single patient are tremendous, said Vivian Ho, the James A. Baker III Institute Chair in Health Economics and a professor of economics at Rice.

“Treating patients in the emergency room is one of the highest costs we have in the health care system,” Ho said, “particularly for heart attacks, because heart disease is the leading killer of Americans and it accounts for a large proportion of our health care costs.

“If we can identify these patients quickly so we can avoid aggressive diagnostic tests further on down the road — for example, cardiac catheterizations and procedures that cost tens of thousands of dollars — by instead using a relatively low-cost diagnostic chip, that’s a tremendous opportunity to provide better care and lower costs,” she said.

McDevitt expects PBNCs and their toaster-sized reader will ultimately find a place at many points of care — hospitals, doctors’ or dentists’ offices, pharmacies and remote clinics worldwide — where they will allow clinicians to quickly diagnose a variety of ailments.

He anticipates Rice’s BioScience Research Collaborative, part of the Texas Medical Center, to be the hub of a pipeline in which chips will be programmed to spot biomarkers for many important diseases.

“PNBC technology marries medical devices and microelectronics,” McDevitt said, “and it has the potential to revolutionize the flow of information in the practice of medicine while significantly reducing cost. I like to think of it as the iPhone of medicine, with the same potential to be a game changer. And it’s just around the corner.”

The morning he died, during what turned out to be his last hour or so of life, Martin Duffy got up and ran through his daily regimen of stretching, push-ups, and sit-ups. Several months before, cancer had kept him from adding to his extraordinary streak of 40 consecutive Boston Marathons, but he was used to forging ahead when his body said stop.

Take one particular Marathon, probably his 26th. Afterward, he learned he had competed with a broken foot. Realizing at the 2-mile mark that something was amiss, “I divided that race into sections of 6 miles, with each segment a challenge to get through,’’ he told the Globe in 2000. “And somehow I did.’’

In 2009, Mr. Duffy’s string of consecutive completed Boston Marathons was recorded as the third-longest in history when he ran his 40th and final race a few months after being diagnosed with tongue cancer induced by the human papilloma virus. He was 70 when he died Nov. 29 in his Belmont home.

Runners often sought advice from Mr. Duffy, given his experience, and he didn’t stop at simply offering tips on how and where to train. An economist who advised businesses and helped them develop strategies, he was still in touch with friends and clients in his final days.

“He went in to work the week before he passed away,’’ said his wife, Rusty Stieff. And that was after treatment had left Mr. Duffy no longer able to speak. Instead, he carried an index card with bold lettering that said:

Please Excuse Me For Not Speaking. I have throat Cancer And have lost my Voice. Rejoice in your own!

Mr. Duffy never stopped rejoicing in life and in helping others, bidden or unbidden.

“His nickname was Father Martin, and believe me, he wasn’t a priest, but Martin sincerely believed that he could help you with all your problems,’’ said his longtime friend Jim Johnston of the Chestnut Hill neighborhood of Philadelphia, adding with a laugh: “Sometimes he defined problems you didn’t think you had. He stubbornly had answers, and frequently he was right.’’

Martin E. Duffy was born at home in Fall River, where he was the youngest of five siblings and liked to say that he started running as a child, to and from stores when he was sent on errands. He was captain of the track team at Durfee High School and set aside running at Tufts University, which he attended on an academic scholarship. He graduated in 1963 with a bachelor of arts in history and a bachelor of science in electrical engineering.

“He was such a renaissance man,’’ his wife said. “I mean, who majors in engineering and history?’’

Mr. Duffy served in the US Navy as a lieutenant with a Seabee battalion with the Civil Engineer Corps, then went to the Wharton School of the University of Pennsylvania in Philadelphia, graduating in 1967 with a master’s in business administration.

He continued his graduate studies at the university in applied and general economics, finishing everything but his dissertation while serving as an assistant dean and as associate director of the Fels Institute of Government. In recent years, Mr. Duffy was on the adjunct faculty at Emmanuel College and Suffolk University, teaching management and economics.

Returning to the Boston area in 1973, Mr. Duffy was director of financial analysis at Harvard University and assistant to the financial vice president, jumping two years later to McGraw-Hill, where he was a vice president and chief consumer economist. In 1986, he founded the Perseus Group, an economic research and consulting firm for which he specialized in forensic analysis.

His first marriage, to Irene Maxx Duffy of Monrovia, Calif., ended in divorce.

Katie Daley Duffy of Winchester, Mr. Duffy’s daughter from his first marriage, wrote about her father’s running for the Globe in 1997, just before his 28th Boston Marathon.

“For the last few years, my father has claimed at the end of the race that this is his last Boston,’’ she wrote, “but at 56, he still hits his feet to pavement and finds that place within himself where the running literally becomes the rhythm of balance in his life.’’

In 1988, Mr. Duffy married Stieff, whom he had helped train to qualify for the first women’s Olympic marathon trials in 1984. Their daughter, Brianna of Belmont, is also a runner.

For many years, Mr. Duffy coached girls’ soccer and was known for inspirational e-mail that he sent to players and their parents. He also was for many years a Town Meeting member in Belmont.

“He really was an exceptional guy,’’ Johnston said. “In many ways, he was better than the rest of us.’’

A service has been held for Mr. Duffy, who in addition to his wife, two daughters, and former wife, leaves two sisters, Janice Kirkman of Swansea and Anne Kenney of Hancock, N.H.; two brothers, Arthur of Stonington, Conn., and Tom of Rocky Point, N.Y.; and two grandchildren.

“He wasn’t afraid of death, but he loved life so much,’’ Stieff said. “He embraced it and exalted in it. Even as his cancer grew, he found new ways of engaging in life.’’

The uphills and downhills that the decades bring, Mr. Duffy said, are reflected in the 26.2 miles runners travel from Hopkinton to Copley Square.

“Life is a little like the Boston Marathon,’’ he told M. Nicole Nazzaro for Runner’s World magazine. “It is an allegory from bucolic Hopkinton through Natick, Wellesley, and Newton to the City on the Hill, Boston. And in the beginning, you get lulled by its ease. From Hopkinton Green, the course opens downhill. It starts easy — maybe way too easy. And so you overdo and thrill in the fast miles. The hills and the challenges are down the road and way in the future [‘and I’ll even feel better then!’].’’

As with life’s twists and turns, he added, the Marathon course can at times be misleading.

“After that last long downhill in Wellesley, the course starts uphill at Mile 16, crossing over Route 128. You thought you paced yourself conservatively, but now you find out. And then even as the crest of Heartbreak falls behind you at Mile 21, you discover another test, the downhills past Boston College that tear up your quads. You look at the CITGO sign on Boylston Street, but it just seems to stay in the same place until finally the last mile opens up to you.’’